Timothy J. Servoss

Examining College Students' Intentions to Become Organ Donors

ABSTRACT 502 university students completed survey items on attitudes, experiences, knowledge, and behaviors related to organ and tissue donation (OTD). Despite positive attitudes toward organ donation, only 11% of students formally have declared their intentions to donate through the state registry or by signing an organ card. When asked to report why they have not signed an organ donor card/registry, students reported, “not considering the topic,” “intentions to donate in the future,” and “general negative attitudes” among other reasons. Students also reported a generally positive attitude toward the topic of OTD and moderate to strong intentions to become organ donors in the future despite feeling somewhat uninformed on the topic. The results are discussed in relation to future campaign message strategies to promote OTD to university students.

Toxicology screening results : Injury associations among hospitalized trauma patients

BACKGROUNDnSubstance abuse is associated with injuries, but these associations have not been well characterized by type of substance and injury type.nnnMETHODSnA cross-sectional study of patients selected for toxicology screening compared those with positive and those with negative test results for drugs and alcohol.nnnRESULTSnPatients with positive alcohol toxicology results were more likely to have violence-related and penetrating injuries than patients with negative results. However, after adjustment for positive cocaine toxicology results, the association between alcohol and penetrating injury was no longer significant. Positive test results for any drug were not associated with any specific injury type, but cocaine was independently associated with violence-related injury. The associations of alcohol and cocaine with violence-related injury appear to be additive. In contrast, opiates were independently associated with nonviolent injuries and burns.nnnCONCLUSIONSnAlcohol and cocaine use is independently associated with violence-related injuries, whereas opiate use is independently associated with nonviolent injuries and burns.

Primary Care After Psychiatric Crisis: A Qualitative Analysis

PURPOSE Patients with serious psychiatric problems experience difficulty accessing primary care. The goals of this study were to assess whether care managers improved access and to understand patients’ experiences with health care after a psychiatric crisis. METHODS A total of 175 consecutive patients seeking care in a psychiatric emergency department were randomly assigned to an intervention group with care managers or a control group. Brief, semistructured interviews about health care encounters were conducted at baseline and 1 year later. Five raters, using the content-driven, immersion-crystallization approach, analyzed 112 baseline and year-end interviews from 28 participants in each group. The main outcomes were patients’ responses about their care experiences, connections with primary care, and integration of medical and mental health care. Scores for physical function and mental function were compared by analysis of variance (ANOVA). RESULTS At baseline, most participants described negative experiences in receiving care and emphasized the importance of listening, sensitivity, and respect. Fully 71% of patients in the intervention group said that having a care manager to assist them with primary care connections was beneficial. Patients in the intervention group had significantly better physical and mental function than their counterparts in the control group at 6 months (P = .03 for each) but not at 12 months. There was also a trend toward functional improvement over the course of the study in the intervention group. CONCLUSIONS This analysis suggests that care management is effective in helping patients access primary care after a psychiatric crisis. It provides evidence on and insight into how care may be delivered more effectively for this population. Future work should assess the sustainability of care connections and longer-term patient health outcomes.

Toxicology Screening in Orthopedic Trauma Patients Predicting Duration of Prescription Opioid Use

Abstract Following hospitalization for orthopedic trauma, some patients continue to use opioids following fracture healing. This retrospective cohort study of 50 patients with high-energy fractures was conducted to determine if toxicology screening tests upon admission can predict subsequent opioid use. Data were collected from clinical records and a statewide electronic database of prescription records. Six months following hospital discharge, those with positive toxicology used more opioids (730 mg vs. 364 mg; P=.04) expressed as morphine equivalents than those with negative toxicology and were more likely to continue using opiates at the end of the 3rd, 4th, 5th, and 6th month after discharge. Patients hospitalized for high-energy fractures with positive admission toxicology are at risk for prolonged opiate use during the initial six months following discharge.

The Association Between Perceived Social Support and Health Among Patients at a Free Urban Clinic

OBJECTIVEnThis study examines the association between perceived social support and the prevalence of physical and mental health conditions among adult patients of an urban free medical clinic.nnnMETHODSnPatients (n = 289) completed a health risk assessment (HRA) questionnaire that addressed a number of medical and social issues, including perceived social support and whether patients had been told they had certain health conditions. Among these questions were 2 validated instruments: the PRIME-MD for mental health disorder assessment and CAGE for alcohol risk assessment. A deidentified database of responses was analyzed for statistical associations between perceived social support and these health conditions.nnnRESULTSnAmong those with insufficient perceived social support there were higher rates of having physician-measured overweight/obesity, a heart condition, a previous heart attack, anxiety, and depression. The association between perceived social support and cardiovascular health existed among women but not among men. Higher income, not smoking, and consumption of high-fiber foods were associated with sufficient social support.nnnCONCLUSIONnPerceiving sufficient social support was associated with lower rates of several mental and physical health disorders. Social support may act as a barrier or buffer to poor health caused by the stressful living conditions often experienced by low-income underinsured people. Males and females may experience this social support buffering differently.

The health status of patients of a student-run free medical clinic in inner-city Buffalo, NY.

Background: This study explores the health status and the social and economic correlates of adults 20 years of age and older who presented at an urban free medical clinic in Buffalo, NY, between 2002 and 2005. Methods: Clinic staff asked patients to fill out a Health Risk Assessment questionnaire that addressed their chronic disease and illness history, mental health, social support, substance use, income, education, and housing. Through statistical analysis of 469 anonymous patient questionnaires, we identified prevalent health conditions in this patient population and compared these rates to regional and national data. Results: Of those patients 20 years of age and older, 70% earned less than US

Differences among those who complete and fail to complete inpatient detoxification

10,000 a year. The rates of obesity, hypertension, asthma, diabetes, anxiety, and depression were higher in this population than in the Buffalo, NY, region and the general United States population. Conclusion: The data reflect the health disparity experienced by low-income minority populations in the United States and emphasize a need to plan additional services that target hypertension, heart disease, obesity, diabetes, and mental health disorders such as anxiety and depression. Findings also serve as an introduction to the patient population for volunteer medical students who have limited exposure to urban, low-income populations.

The Role of Direct-to-Consumer Pharmaceutical Advertisements and Individual Differences in Getting People to Talk to Physicians

Abstract Some individuals hospitalized for alcohol or drug detoxification leave against medical advice (AMA). We hypothesized that certain characteristics would be associated with AMA discharges. A case-control study of 1,426 hospital admissions for detoxification (representing 1,080 individuals) was conducted to compare patients leaving the hospital AMA (n = 231) with a random sample of those completing detoxification (n = 286). Latino ethnicity, detoxification from drugs, Friday or Saturday discharge, Medicaid or no health insurance, and not being treated by one specific attending physician were characteristics associated with an AMA discharge in a backward logistic regression model. Although 85% of the patients with all these characteristics left AMA, only one patient, without any of these five characteristics, did so. We conclude that clinicians can use certain clinical features to predict AMA discharge. Additional research could evaluate if treatment strategies that consider these ethnic and socioeconomic disparities may reduce rates of AMA discharge.

Understanding health inequalities for uninsured Americans: a population-wide survey.

In this study, 384 respondents provided quantitative and descriptive information about direct-to-consumer (DTC) pharmaceutical advertisements and factors related to message reception and drug adoption. The authors applied M. Booth-Butterfields (2008) Standard Model to explain how DTC advertising is used in getting individuals to talk to their doctors about pharmaceutical drugs. The researchers predicted that individuals who talked with their physicians about a pharmaceutical drug (referred to as talkers) would differ from those who did not talk with their physicians (referred to as nontalkers) in a number of meaningful ways. Findings from this data set indicate that individuals who talked with their physician about a specific medication were more likely to be female, older, higher in need for cognition, and reported higher physician satisfaction. Total number of channels (TV, radio, newspaper, magazines, and the Internet) was negatively associated with talking to a physician about a specific medication, as was exposure to DTC advertisement on television. The authors offer explanations for these findings along with descriptive accounts of how talkers and nontalkers differed in their recall of DTC advertisement information.

Educating Young Men About Testicular Cancer: Support for a Comprehensive Testicular Cancer Campaign

Numbers of the uninsured in America have risen in the past few years to more than 40 million people, yet relatively little is known about their health communication behaviors. Data from the 2003 Health Information National Trends Survey (HINTS) were used to analyze the relationship among demographics, health status, health insurance status, online health seeking, and amount of attention paid to various media for health. A random sample of 6,369 Americans indicated several statistically significant differences between the insured and uninsured: the uninsured were more likely younger, less educated, and Hispanic. Findings also indicated that those without health insurance reported being less healthy and more distressed and hold a greater risk perception for cancer, compared with their insured counterparts. Health insurance, when controlling for demographics and health status, explained a statistically significant but small amount of variance in both online health seeking and attention to health messages in various other media.